Provider Demographics
NPI:1407856065
Name:COATES, GLORIA JEAN (RPH)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:JEAN
Last Name:COATES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 STEPPINGSTONE SQ
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2517
Mailing Address - Country:US
Mailing Address - Phone:757-424-8256
Mailing Address - Fax:757-424-8310
Practice Address - Street 1:2100 STEPPINGSTONE SQ
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2517
Practice Address - Country:US
Practice Address - Phone:757-424-8256
Practice Address - Fax:757-424-8310
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist